The value of Wound, Ischemia and foot Infection classification in patients undergoing endovascular therapy

Marcos Roberto Godoy; Francisco Cardoso Brochado-Neto; Marcelo Fernando Matielo; Marcus Vinícius Martins Cury; Renato Manzioni; Roberto Sacilotto

doi:10.1016/j.jvs.2023.07.056

The value of Wound, Ischemia and foot Infection classification in patients undergoing endovascular therapy

J Vasc Surg. 2023 Nov;78(5):1260-1269. doi: 10.1016/j.jvs.2023.07.056. Epub 2023 Aug 3.

Authors

Marcos Roberto Godoy¹, Francisco Cardoso Brochado-Neto¹, Marcelo Fernando Matielo², Marcus Vinícius Martins Cury¹, Renato Manzioni¹, Roberto Sacilotto¹

Affiliations

¹ Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil.
² Department of Vascular and Endovascular Surgery - Institute of Medical Assistance to the State Public Servant, Sao Paulo, Sao Paulo, Brazil. Electronic address: matielo@gmail.com.

PMID: 37541557
DOI: 10.1016/j.jvs.2023.07.056

Abstract

Objective: This study aimed to evaluate the correlation between the Society for Vascular Surgery (SVS) Wound, Ischemia and foot infection (WIfI) classification system and clinical outcomes for 1-year limb amputation-free survival (AFS), freedom from reintervention, and wound healing rate in a cohort of patients affected by chronic limb-threatening ischemia treated exclusively by endovascular procedures.

Methods: We analyzed a prospective, consecutive cohort of 203 patients (203 limbs) who underwent infrainguinal endovascular revascularization at a single center between March 2018 and January 2021. These patients were stratified into clinical stages 1 to 4 based on the SVS WIfI classification and categorized into two groups: WIfI 1 to 3 (n = 101 limbs) and WIfI 4 (n = 102 limbs). The SVS objective performance goals of 1-year limb AFS, freedom from reintervention, and wound healing were compared between the groups and assessed using the Kaplan-Meier method. Angiographic lesion characteristics and angioplasty details were compared.

Results: The average age was 72.4 years (44.3% male, 85.2% had hypertension, 80.3% had diabetes, and 87.7% had tissue loss). There were statistical differences between the groups in 1-year limb AFS Kaplan-Meier rate between WIfI clinical stages 1 to 3 group and WIfI clinical stage 4 group (82% vs 66%, respectively; P < .001), but there was no statistical difference in freedom from reintervention and wound healing rates between the groups (70% vs 64% [P = .62] and 74% vs 79% [P = .90], respectively). Owing to angiographic lesion characteristics, femoropopliteal and infrapopliteal segment distributions were similar between the groups, but there was a statistical difference in target lesion location to tibial vessels (55.4% vs 71.6%, respectively; P = .025).

Conclusions: In this cohort of patients with chronic limb-threatening ischemia, SVS WIfI clinical stage 4 had worse results in the 1-year limb AFS rate, but there was no statistical difference in freedom from reintervention and wound healing rates between the groups.

Keywords: Amputation; Angioplasty; Atherosclerosis; Foot infection; Peripheral arterial occlusive disease.